by Allen Wyler
“Want a word of advice?” Baxter offered. “Best way to pass the orals is to do exactly what you’ve been trained to do during teaching rounds. The examiners aren’t looking for right or wrong answers. They want to find out how you approach clinical problems. The best strategy is to tell them everything you’re thinking. Don’t stop talking until you’re pretty sure you’ve said every word on your mind and then some. Don’t hide your knowledge. Right, Geoff?”
Geoff kept mixing the coins, then rearranging them. One iteration after the other. Without looking up from his hand, he said, “Know Karl Borne?”
It took Alex a moment to attach a person to the name. “Sorta. But not all that well. He was chief the year I started. We didn’t rotate together—only saw him at conferences. Why?”
Geoff scrambled the coins again. “Heard about his experience on the boards?”
“Experiences,” Baxter said.
“We all like Karl.” Geoff shook his head sadly. “Man’s a good neurosurgeon. But when we asked him questions on rounds, he’d defer to one of the other residents. Made them think—and I’m sure this was the case—that he knew the answer and was just giving them a chance to shine. We never forced him to answer,” he said, casting a glance at Baxter, “making us partly to blame. So when he took his orals, he clammed up, just wouldn’t answer. The examiners tried to get him to answer, but the harder they tried, the more he clammed up. Flunked it. To this date, he’s this program’s only graduate to never pass orals. We were all horrified. We even brought him back for a day of special coaching and thought we’d gotten him over the hump, but when he took them the second time, same thing happened. Never tried after that. Said he refused to submit to that degree of humiliation again. It’s a shame, too, because he’s a good clinician. Right, Baxter?”
Baxter blinked twice. “Agreed.”
“So you guys will write me recommendations?” Alex said, looking from one to the other.
“You bet,” Geoff said.
“We will,” seconded Baxter.
“Thanks.” Alex withdrew sheets of paper from a manila folder and handed one to each of them. “Here is the info. I’d appreciate it if you’ll dictate them this afternoon so they can go out in the morning mail.”
Geoff gave his trademark silly grin, exposing acres of glistening gums and tartar caked between his front teeth. Baxter folded his copy lengthwise to slip in his white coat. Standing to leave, Alex looked both men in the eye. “Today, right?” Baxter nodded. Geoff just grinned.
7
“I’m in the kitchen.”
“Be right there.” Alex hung his coat in the hall closet under the stairs to the second floor and headed into the kitchen where Lisa sat at the bistro table sipping a glass of white wine, looking very upset.
“Bad day?” he asked while removing a wine glass from the cupboard.
She finger-combed her hair then shook it out. “Laura called.”
He knew of two Lauras in her life: her sister and a friend. “Your sister?”
“What other Laura is there?”
Whoa. Not good, whatever was upsetting her. Long ago he’d learned that when she showed this mood, he should simply allow her to raise the problem on her own terms rather than prying it out of her. He picked up the wine bottle to pour a glass and was surprised at how light it felt. He held it up to check the level. Three quarters gone. Not good at all. “Go on with your story.”
“She called about Mom.”
He poured some wine and set the bottle on the table. “What’s wrong?”
“You probably don’t remember me mentioning the chronic cough she developed, but it became progressively worse, so she saw her doctor. Turns out it’s lung cancer.”
Ah shit. He wanted to reach across the table to take her hand, but knew she’d pull away. She got like that when depressed or upset or both. “I’m sorry. Has it been staged yet? Know any more details?”
“She said it’s too advanced for them to consider surgery, so her only options are radiation or chemotherapy—one or the other, but not both. Laura wants me to come home soon as possible.” She dumped the remainder of the wine into her glass.
“I’m so sorry, Sweetie. Of course you’ll go. Have you booked a flight yet?”
She shook her head. “No. I wanted to talk to you first.”
He didn’t see any need for discussion. “What’s to talk about? You’re going.”
“Will you come with me?”
He considered that a moment. “How long?”
“Christ, Alex, how should I know? However long it takes.”
“I don’t know how soon I can get away. I’ll have to arrange coverage. Why don’t we get you back there first, and I’ll come soon as I can.”
She flashed exasperation. “But I want you there to explain things. You know how I am about medical things.”
“Honey, I’ll see what I can do. It’s going to be difficult getting someone to cover the trauma center. That’s the best I can say right now.” Feeling trapped, he sipped wine and waited. She was rotating her wine glass by the stem now, making little screeching sounds as the glass rubbed the marble.
“Why don’t you open another bottle?” she said at last, clearly not making it optional. “We can have a little while I heat up the chicken.”
“Okay.”
He removed the one remaining bottle from the small countertop wine rack. As he stripped foil from the neck, he heard a sigh. Not just any sigh, but her proprietary I’m-fed-up-with-this sigh.
“Know the one thing I resent the most in our marriage?” she asked.
Okay, here we go.
Without a word, Alex screwed the opener into the cork. This was her classic gambit. Nothing he could say or do at this point would alter the ensuing argument. Often, when frustrated or angry—especially when fueled by wine—she had an urge to beat up on him, as if him serving as an emotional punching bag was a given in the “for better or worse” clause of their marriage vows. Didn’t mean he liked it.
When he refused to take the bait, she continued. “That you’ve never loved Mom. Not like Dan does. He still sends her a Christmas card every year.”
Working on prying the cork out, he wondered if Dan—Lisa’s first husband—really loved Donna or if Lisa just used this phrase to try to make him feel guilty for his lack of connection with her mother. Did it make a damn bit of difference? It was something that would never be reconciled.
“Why don’t you like her?” Lisa asked.
Alex turned toward her, bottle and corkscrew in hand. How many times had they discussed this? “Look Sweetie, I don’t dislike her. For whatever reason, we’ve never been able to resonate. If I try to talk with her, she clams up. What am I supposed to do?”
“She’s extremely passive, Alex. Extremely passive. She never takes the lead on anything. You know that. But you don’t like passive women. You don’t respect passive women. You only like strong women, just like your Mommy.”
Okay, there it was. Squelching a retaliatory zinger, he popped the cork, perhaps with a bit more force than necessary. “Being passive and non-communicative are two entirely different things. She won’t say much more than yes or no to anything I say. What more do you expect me to do? You just said it; she’s passive. I can’t change that.”
She glared at him. “For one thing, you could try to be a bit more understanding. Maybe if you did, you’d be able to accept her.”
They were on a path traveled too many times where he was the villain and Donna was the victim. He debated the wisdom of pouring her any more wine, but decided hiding it would only inflame her even more. So, without a word, he brought the cabernet to the table.
“We’ve been over this, Alex. The reason she can’t talk with you is you intimidate her. We grew up poor. My father was a farmer. There’s never been a doctor or lawyer or any other professional in our family. The only doctor we knew was the vet. She doesn’t know what to say to you. She’s afraid of saying the wrong thing and that you’ll
laugh at her and think she’s stupid and uneducated. She’s a smart woman, Alex. Maybe not university educated, but smart in other ways. Is that so hard for you to understand?”
Best strategy now, he decided, was to change the subject. He poured more wine and hoped for the best. “Let’s try to think of a way to get you home soon as possible.”
8
“Welcome back,” Geoff said as Alex entered the conference room. Baxter, Ogden, and Waters sat at the square table in the break room. The other half of the room contained a large conference table, separated from the coffee area by an accordion divider that was presently closed. Muted voices could be heard from the other side, most likely from a secretarial staff meeting underway.
“Thanks.” Alex went straight to the coffee pot, found his cup on the drain board, and poured it half full.
“How did it go?” asked Baxter.
Alex took the remaining chair. “I feel good about it,” he said, then laughed at a memory. “Got off the plane and went out to the curb for a cab. The guy in line right in front of me was holding a thick neurosurgery text, so I asked if he was there for the boards. He was, so I suggested we share a cab to the hotel. On the trip in, I asked if he wanted to have dinner, but he said he was getting room service so he could spend the night cramming. Can you believe that? Cramming? I mean, if you don’t know the material by then, one night of reading a textbook isn’t going to help. Besides, how can you expect to cover the entire field?”
“You didn’t study that night?” Baxter asked with a sarcastic chuckle.
Alex smiled. “I bought a paperback—Marathon Man—at the airport. You know, something to read on the flight. Stayed up half the night to finish it. Had breakfast with him the next morning. I was one of the lucky ones who were assigned the morning group, so soon as I finished breakfast, I went upstairs to the exam. I finished up before noon and was able to catch an earlier flight back.”
“Any section give you problems?” Waters asked. The orals contained three one-hour sections: cranial neurosurgery, spinal/peripheral nerve surgery, and neurology. Individual candidates rotated from one room to the next every fifty-five minutes. Each session contained two examiners with one observer to monitor the process.
“No, not really—don’t think I dug myself any holes.”
“How about the neurology section?”
Alex shrugged. “Seemed to go okay. Turned out I only had one case: a fifty-five-year-old male with tingling in his feet. The neurologist who presented the patient asks, ‘What would you do now?’ I say, ‘Take a history.’ He says, ‘Go ahead, take it.’ So I started in asking him questions. Went on and on and on like this until I’m down to two probable diagnoses, cervical spondylosis with cord impingement or Vitamin B12 deficiency. The neurosurgeon—I forget his name—was a real bear, too. When we reached that point, he asks, ‘What do you do now?’ I said, ‘Draw a B12 level and then give the patient a shot of B12. I’d have him return in a week for follow-up.’ The neurologist says, ‘You wouldn’t just take him to the OR to decompress that spine? It looks like hell,’ and he points at the X-rays. He says it as if I just buggered his dog, so I think maybe I just blew it. But I decided to stick with my answer, especially this being the neurology section. I told them it wouldn’t hurt to wait for a week before offering the patient surgery. I hoped they’d tell me if I got it right, but just then we ran out of time. I was floored. We spent the entire hour on just that one case. Couldn’t believe it.”
Waters smiled while checking his watch, slapped his thighs, and stood. “Have a conference call in three minutes. NIH. I’ll leave you three to your war stories.” He looked at Alex. “I suspect that was the right diagnosis. You were correct: in the neurology section they’re most likely to discuss a nonsurgical case. They wanted to find out if you could tell the difference between those two diseases since they mimic one another so closely. The board isn’t in the business of certifying a bunch of scalpel-happy cutters. I suspect you did just fine.”
After Waters left the room, Geoff spoke up. “Going to be a much different department without him around.”
Alex did a double take. “Why? He going somewhere?”
Geoff glanced at Baxter, then back to Alex. “You don’t know? He just turned sixty-five. That’s the mandatory retirement age for professors here. You can stay on in emeritus status for two years, but only at the pleasure of the new chair. After that, you’re required to leave.”
Was that a note of anticipation in Geoff’s voice? Alex studied him and saw no sign of sadness or regret. “But he trained you and brought you onto the faculty.”
“So?” Geoff glanced at Baxter with a bemused expression.
Baxter chimed in. “Those are the rules here. For good reason, too. It allows room for younger people like you. This place isn’t like some schools where junior people are forced to play Dead Man’s Boots until a position opens up.”
Showing even more of his glistening gums, Geoff smiled and added, “Dean already formed a search committee.” Throwing it out there casually.
Baxter and Geoff waited for the words to sink in, as if reading Alex’s mind. Stunned by their callous disregard for the man who’d brought them up through the ranks, Alex remained speechless.
“You realize, of course, you’ll probably be interviewed by the search committee,” Baxter added.
Alex was having difficulty paying attention to the conversation now. “No, I didn’t.”
“Count on it,” Geoff said. “They’re bound to ask questions about the department, where you think it should be in five or so years. These days, a department like ours—with a strong heritage of clinician research—simply can’t be sustained. Deans are facing severe financial difficulties, especially when having to support non-revenue-generating departments like anatomy or physiology. They’re forced to use their clinical departments to generate income. So, of course, this means the dean will be tempted to look outside the present faculty for someone who doesn’t hold research with the same respect as Waters has. Faculty such as yourself will be vulnerable. Right, Baxter?”
“Absolutely.” He nodded emphatically. “So when you interview with them, expect to be asked if any of us would make a good replacement.” Baxter locked eyes with Alex. “Or are you considering tossing your hat in the ring?” Blink, blink.
Alex recoiled. “You serious?” When neither man answered, he realized they were. “Of course not. I’m too inexperienced. Why would I even think of that?”
Smiling, Geoff nodded approval. “That’s what I thought. Point is, both Baxter and I are being considered. We encourage you to be extremely circumspect in everything you say during your interview. Think about your lab and all it means to you. Think about how we—the present faculty—cover your salary so you can continue to apply for grant support. Think about how both Baxter and I would maintain the status quo if either one of us became chair.”
Jesus, a campaign speech.
Baxter chimed in. “You don’t have any outside candidate in mind, do you?”
Outside candidate? Of course not. He hadn’t even wrapped his mind around the idea of Waters not being there. A foreboding sprouted deep in his gut. As Baxter just pointed out, he was the only nontenured faculty member, making him vulnerable. Why hadn’t he factored in Waters’s age when considering this job? Too late now.
He realized they were waiting for an answer. To what? Oh yeah—did he have an outside candidate in mind?
“No. If you’ll excuse me,…” He needed to be alone and think.
9
“Afternoon, Dr. Cutter.” Nancy, Geoff’s secretary, nodded to him as he passed her desk on the way to the departmental mailboxes.
“Afternoon, Nancy. How goes it?” He retrieved the handful of mail, memos, and sundry messages that had accumulated since the day before.
She rolled a fresh sheet of white paper into her typewriter. “It’s Friday, so life is good.”
Back in his office, he began sorting mail, tossing junk into
the wastebasket. Two items immediately caught his attention—a letter from NIH and a headline in the American Association of Neurological Surgeons (AANS) newsletter: “Welcome Our New Members.” The article listed all new members. Eagerly, Alex scanned the list for his name.
Not there.
After a stunned moment, he scanned the list again. Still not there. His gut tightened with anxiety. A simple mistake, an oversight?
Or …
Had he been rejected?
Wouldn’t AANS headquarters notify him if that happened?
Okay, so what could’ve possibly gone wrong? He ticked off the steps he’d taken: he submitted the completed application via FedEx, and its arrival had been confirmed. Check. The application had been filled out correctly. Check. He passed his boards. Check. He obtained the required number of recommendations from AANS members. Hmm …
The vague noxious feeling in his stomach intensified, making him nauseous.
He leaned back, gulped a few deep breaths to collect himself, then leaned over and opened the door. Rip, the secretary he shared with Baxter, sat in the cramped reception area just outside their offices, wishbone earphone in place, typing away on her IBM Selectric. He paused to settle his nerves. “Hey Rip, got a minute?”
She stopped typing, left foot automatically releasing the dictation pedal, and removed the earphones. “You bet. What can I do for you?”
“You remember typing a letter of recommendation from Baxter in support of my AANS application?”
She thought a moment, then turned to a file drawer. “Must’ve been six weeks or so. Have it right here. Want to see it?”
He held up a palm. “Whoa, no, that’s confidential. But tell me something.”
She pulled a sheet of onionskin from the files and held it up. “Don’t think he’d mind. He was very supportive.”
Alex smiled. “You just answered my question. Thanks. Sorry to interrupt your concentration.” Her nickname “Rip” came from an ability to rip through dictation at incredible speeds, her entire demeanor efficient: placid expression, eyes closed, fingers flying across the electric typewriter. She exhibited an uncanny ability to know when reaching the bottom of a page without bothering to look. When she caught up on Baxter and Alex’s work, she cheerfully picked up other dictation from the secretarial pool.
